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Dr. McCann is a psychiatrist and directs the Anxiety Disorders program at Johns Hopkins Medicine. Learn more about Dr. McCann.
The association between anxiety and heart disease has not been as fully studied as the relationship between depression and heart disease. However, Dr. Una McCann, Professor of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, believes the connection is strong.
“It’s my view and my personal clinical experience that anxiety disorders can play a major role in heart disease,” says Dr. McCann. “I believe that a really careful look at anxiety would reveal the ways it can severely impact heart disease, both as a contributing factor and as an obstacle in recovery.”
A natural reaction to a sudden heart attack can be similar to post-traumatic stress disorder:
When someone is anxious, their body reacts in ways that can put an extra strain on their heart. The physical symptoms of anxiety can be especially damaging among individuals with existing cardiac disease.
Anxiety may have an association with the following heart disorders and cardiac risk factors:
Anxiety disorders come with a high degree of fear and uncertainty. When this fear and certainty keeps the heart attack or heart disease patient from following the advice and treatment plan of their cardiologist, it can have a major impact on recovery. Anxiety can interfere with:
Anxiety disorders fall into several categories. Here are a few of them:
Panic attacks and heart attacks can share similar if not identical symptoms. Anyone suffering from sudden and severe chest pain—whether being treated for anxiety disorder or not— should go to the emergency room. The physician will test the patient’s blood for specific heart muscle enzymes. If none are found, it’s usually not a heart attack.
A cardiologist sensitive to the issues of anxiety and depression will know how to sort out panic attack symptoms from heart attack symptoms, and will be able to refer the patient for treatment for panic disorder or any other type of anxiety.
It’s important to differentiate normal anxiety from the more severe type. Does the anxiety interfere with your family life or keep you from being productive in your professional life? Does it restrict you from engaging in the activities you like? If the answer is yes, then it’s the kind of anxiety that may require some degree of therapy or medical attention.
Depending on the duration, severity, and type of anxiety, treatment can include therapy, medication, or a combination of both. A common and effective method of treatment is cognitive behavioral therapy (CBT), which involves three main components:
Women are about twice as likely as men to experience panic disorder, generalized anxiety disorder (PTSD), social phobia, and anxiety disorders when taken as a whole. Women are also more likely than men to get post-traumatic stress disorder, even though men are more likely to be exposed to violent and dangerous situations.
One reason may be that the types of traumas that women experience most—sexual trauma and rape—are more likely to lead to post-traumatic stress disorder. PTSD is one of the many types of anxiety that can put stress on the heart.
“Just like a major heart attack, a burn is a horrible thing, says Dr. McCann. “About 33% of patients who have really severe burns develop post-traumatic stress disorder. Which makes us wonder about the 66% who do not get PTSD. We think genes are a huge part of it. We’re currently researching whether this same genetic vulnerability holds true for cardiac disease.”